Cerebral white matter lesions, vascular risk factors, and cognitive function in a population‐based study

Abstract

Cerebral white matter lesions are a common finding on MRI in elderly persons. We studied the prevalence of white matter lesions and their relation with classic cardiovascular risk factors, thrombogenic factors, and cognitive function in an age- and gender-stratified random sample from the general population that consisted of 111 subjects 65 to 84 years of age. Overall, 27% of subjects had white matter lesions. The prevalence and severity of lesions increased with age. A history of stroke or myocardial infarction, factor VIIc activity, and fibrinogen level were each significantly and independently associated with the presence of white matter lesions. Significant relations with blood pressure level, hypertension, and plasma cholesterol were present only for subjects aged 65 to 74 years. White matter lesions tended to be associated with lower scores on tests of cognitive function and were significantly associated with subjective mental decline. This study suggests that classic cardiovascular risk factors, as well as thrombogenic factors, are associated with white matter lesions in subjects over 65 years of age in the general population, and that these lesions may be related to cognitive function.

Cerebral complications of hypertension

“…The negative effect of high blood pressure levels on intellectual performance could also be linked to alterations in the cerebral white matter, as suggested by the Rotterdam study which has highlighted the predominant role of risk factors for atherosclerosis in the development of brain lesions and cognitive deterioration. 105,106 Hypertension and white matter lesions Leucoaraiosis and white matter lesions refer to white matter hypodensities on computed tomography and hyperintensities on T2-weighted MRI images, respectively. The pathogenesis and clinical correlates of age-related white matter lesions are still unclear.…”

“…107 The main risk factors for white matter lesions are hypertension, particularly high systolic blood pressure, 101,108,109 although some authors have reported either no or an inverse association with blood pressure. 94,110,111 White matter lesions have also been associated with vascular risk factors including history of stroke, 105,110 heart disease, 105,110 atrial fibrillation 110 and diabetes mellitus. 112 The main hypothesis regarding the cause of white matter lesions is that long-standing hypertension may cause lipohyalinosis and thickening of the vessel walls with narrowing of the lumen of the small perforating arteries which could lead to ischaemia in the terminal distribution territories of these vessels, ie, deep white matter.…”

Classification of White Matter Lesions on Magnetic Resonance Imaging in Elderly Persons

“…WMLs are commonly seen on MR images of elderly people. MRI lesion prevalence in community-dwelling elderly was reported to range from 5.3% to 100%, depending on study design, study population, and assessment method (1)(2)(3)(4)(5).…”

“…Furthermore, WMLs are related to various geriatric disorders: cerebrovascular diseases (11)(12)(13), cardiovascular diseases (1,9,14), dementia (15)(16)(17), psychiatric disorders such as major depressive disorder (18)(19)(20), bipolar disorder (21), and schizophrenia (22), neurologic disorders such as multiple sclerosis (23) and normal pressure hydrocephalus (24), and inflammatory diseases such as systemic lupus erythematosus (25). Therefore, the presence, form and severity of WMLs may provide additional characterization of aging, pathophysiology of geriatric disorders, and the relation between aging and geriatric disorders.…”

Long-term Blood Pressure Variability and Cerebrovascular Changes on CT in a Community-based Elderly Population.

“…Although the pathogenesis of WML is incompletely understood, similar underlying mechanisms (small-vessel vasculopathy) for WML and SI were suggested by several studies. WML was associated with vascular risk factors 1,18,14), the presence of SI 6), and cerebral hypoperfusion 2$2$21,2 . On the other hand, the etiology of WML seems to be related to a specific type of cerebral ischemia 26) ; some investigators found no definite relation between periventricular white matter lesions and arteriosclerosis .…”